Tangled Minds: The Link Between Creativity and Bipolar Disorder

Highly creative? Outside the box thinker? You might be more prone to mental illness.

Creative individuals have a higher risk for pathology from mood disorders, schizophrenia spectrum disorders and substance abuse issues4. For some of these creative types, depression or anxiety stems from seeing things differently compared to those around them. In other cases, condition symptoms lead to a need for some type of outlet, and creative endeavors like art or writing fit the bill.

However, many have creative minds as a symptom of their diagnosis because the same systems that trigger the condition also lead to the ability to think creatively. This seems particularly relevant in the case of bipolar disorder.

Now this is surely not to assert that everyone with bipolar disorder is a creative genius, or that those who happen to be creative necessarily suffer from bipolar disorder. Instead it is more an exploration of how those things might go together. Because creativity is pretty bad ass and we all want to know some of the things that cause it right?

Let’s take a ride.

First Things First: What Does Bipolar Disorder Look Like?

Well, it sort of depends. I know that’s super clinical. But it is a difficult question to answer because the symptoms are a little bit different in each individual and it’s hard to say which symptoms will cause the most suffering. Will someone have more trouble in their daily lives during depression, or when they are manic? Will they experience a mixed episode where the symptoms of mania and depression occur at the same time?

A word to the wise about trying to self diagnose in your living room: just don’t do it. Everyone will have some of these symptoms. (Now let me go take off my bossy pants and put on my yoga pants again. The way it should be.)

Some people enjoy their manic phases due to symptoms like:

Euphoria

Increases in physical activity

Higher self worth

Higher motivation/drive

Insomnia, or less need for sleep

Bursts of creativity (in some)

Sounds great right? Unfortunately with those positives come negatives. It’s like Mother Nature gives you a few good things and then kicks you in the balls.

Manic episodes may also come with:

Irritation or anger

Aggression

Trouble with judgment which might include risky behaviors like spending sprees, calling into work or use of substances

The way people shift between these phases varies greatly. Those who have more than four mood shifts a year are considered to be “rapid cyclers’ though some change in the course of a few hours. Many also experience changes in mood with the change of seasons, like that present in Seasonal Affective Disorder (SAD). However, as opposed to SAD where depression usually manifests in winter, in bipolar the depression may show up in either the winter or the summer, with manic episodes occurring in other seasons.

There are also different types of bipolar based on severity. Bipolar I is usually considered the most debilitating. Bipolar I causes significant difficulty in everyday functioning and manic episodes that are often quite severe or dangerous. Bipolar II is less severe than Bipolar I, and those who have it are usually able to carry on with their daily lives. They may have irritability or elevations in mood during manic phases (though not as extreme as in Bipolar I). However, in Bipolar II, depression usually lasts longer which can be distressing. In cyclothymia, symptoms are similar, not as severe as either of the first two, but may still impact daily life.

That’s a whole laundry list of symptoms and types. But why would any of that happen?

Evolution of Bipolar Disorder and the EOBD-R Hypothesis

Okay, so the EOBD hypothesis actually stands for “Evolution of Bipolar Disorder.” I assume they kept it simple because the scientists were exhausted from being all brilliant exploring genomes and coming up with evolutionary reasons for bipolar traits.

Or maybe they were just lazy as shit. I don’t really know. I wasn’t there.

Either way, the EOBD-R hypothesis states that bipolar disorder developed in response to extreme climate conditions in the Pleistocene era, specifically in the northern temperate zone1. And who lived up there? The Neandertal (or Neanderthal). That’s right folks, this condition seems to be related to a specific adaptation derived from Neanderthal genetics1.

According to research published in Medical Hypotheses the circadian gene network—the same one that regulates sleep and wake cycles—is involved in bipolar conditions1. As in Seasonal Affective Disorder, shifts in bipolar often tend to be sensitive to light and season1. This report also notes that both conditions show changes similar to those in hibernating animals, and both may respond to ambient light manipulation (light therapy).

This may explain why some small scale studies found that light therapy is effective in pulling women from bipolar depression, though three of four developed mixed states as opposed to stability5. Other researchers support exploration of dark therapy, where lenses are worn to simulate darkness for longer periods as dark therapy has been shown to help organize and stabilize circadian rhythms6.

But why? What’s with all the light sensitivity? Let’s break this down.

Let’s say I am an early Neanderthal on the frigid tundra. It’s cold as fuck and I need to cut my metabolism real quick to survive on meager resources. When the weather gets dark and the sun is scarce, I need to find a way to get as close to hibernation as possible. That means less movement, more sleep, reduced metabolism. And by far the easiest way to achieve such a goal is to make an organism want to lay around by decreasing motivation. Mother Nature induced depression, at your service.

Okay, so I rest for awhile. But wait…IS THAT THE FUCKING SUN?? I need to kick it into high gear in order to collect all the food and resources I can in a very short time frame. I need to be highly motivated, and no better way to get me to do it than to make me euphoric, excited or even anxious to be out doing what I’m doing. I should also try to get my groove on with as many fellows as possible since who knows when we will be able to run around and procreate again. It’s sexy, goal driven, productive yet highly anxious, because really the sun could slip away at any time. Thanks, Mother Nature (you big jerkface).

These links may also explain it’s heavier prevalence in women of reproductive age, a link which remains in hibernating animals as well. Those early females just had more at stake and had to conform more quickly if they wanted their offspring to survive (or if they wanted to reproduce at all during short periods of resource availability and thus fertility).

So aside from being able to switch activity levels quickly in harsh environments, what else matters for survival?

Well you gotta be able to work with what you have. Think smarter, not harder. In short, you have to be creative.

Creativity, Mental Illness and Bipolar Disorder

Creativity is controlled by dopaminergic systems in the midbrain2, which basically means that if you’re highly creative, your brain uses the neurotransmitter dopamine in a certain way.

But if you don’t want quite that simple (and you know I never do) the skinny is as follows:

Highly creative individuals have lower concentrations of dopamine D2 receptors which may decrease how much information gets filtered, thereby increasing the amount of information able to flow freely from the thalamus to the cerebral cortex3. There’s a lot of brain in that last sentence. How about this: Your brain has a colander inside it.

A…colander? Like that noodle strainer thing that always falls into the sink just when I think dinner’s ready?

Weirdness, I know. But your thalamus is kinda like that. The thalamus is an area of the brain that transmits sensory and motor signals to the cerebral cortex. It also helps to regulate things like sleeping patterns, consciousness, and alertness.

The thalamus serves as a mechanism to filter information. We only register certain parts of our everyday experience. If we registered it all equally, we would be completely overwhelmed. So…thalamus = colander. And in your midbrain, lots of signal information and thoughts are running around trying to get into your conscious awareness. The colander will make sure that only some of that, the most necessary part, gets through to make sure you don’t get overwhelmed. It does this with those D2 receptors. They block things, sort of like making the holes in the sieve smaller.

But, sometimes less is more. If you have fewer D2 receptors in the thalamus, you probably have a lower degree of signal filtering, and thus a higher flow of information from the thalamus3. And as anyone with creative tendencies knows, that “creative flow” is really important to the process whether they are painting, writing or scavenging for scarce resources in a desolate part of the northern tundra during a small window of hospitable weather.

Essentially, the same genetic traits that predispose one to bipolar disorder may also predispose them to creative thought and original ideas. This idea that one set of genetic traits can lead to both negative and positive is called “the silver linings model” or the “At Least My Asshole Dog Fetches The Paper Model.” No, wait…it’s the Shared Vulnerability Model (though I am glad for asshole dog paper fetching).

So all that cognitive disinhibition, where larger amounts of information get through that thalamus-colander thing, can be overwhelming as can neural hyperconnectivity which can lead to connections between seemingly unrelated things. Increased attention on new things may alter ability to focus, and lead to distress. That whole trouble with regulating sleep and wake cycles and cycling between manic and depressive phases might also feel like bullshit that makes you want to throat punch Mother Nature.

But with all these vulnerabilities, the creative may also possess high IQ, higher working memory capacity and enhanced cognitive flexibility4. Those are pretty bad ass traits that allow individuals to think outside the box and survive the Pleistocene Epoch (stupid ice age). It might also let them process larger amounts of stimuli and process it into creative or original ideas when they no longer have to use that creative energy to stay alive.

Treating Bipolar Disorder: Does Treatment Reduce Creativity?

The issue for many suffering from bipolar conditions is that medications to treat the mood swings often dampen creative flow. However, forgoing treatment for this reason may not have merit. Because even though bipolar disorder may predispose one to have the ability for creative focus, it does not necessarily lead to it. The experience of creativity might be hampered by certain personality factors or other neurochemical balance issues. Some studies note that happiness and energy may be more indicative of increased creativity as opposed to the simple “bipolar as creative” explanation7. And reducing the severe manic episodes or depression may even enhance the creative process in those who suffer, though more research needs to be conducted in this area8.

This at least partially explains why a number of studies did not see the links between bipolar conditions and creative process: because no two individuals are the same and a number of systems may play into creativity. For example, serotonin and norepinephrine lower motivation and flexibility which may inhibit creative processes11. Can one predisposed to creativity through the same system that triggers bipolar end up with little or no creative juice if their serotonergic system is out of whack? Science says, "Probably."

As another example, brain derived neurotrophic factor, a protein involved in neuronal healing, may play a role in the negative effects of bipolar disorder. Some studies have found better functioning BNDF systems in those with mania, though these links do not remain for depressed episodes9. Other researchers go so far as to note that regulated levels of BNDF might be indicative of clinical stability10, and if you believe research that happiness assists with creativity7, you might trigger your creative side with stable moods.

Is it possible that one with a genetic predisposition to a dopamine system that allows for enhanced creativity may be thwarted because they also have trouble regulating BNDF? If the latter is fixed will the former respond with enhanced creative flow?

Well, I have no idea, because they don’t have a whole bunch of studies on it to answer that question directly. But it does seem clear that regardless of the potential for creativity, stress and any number of other factors can thwart those efforts even in the most creative of minds.